de Ville de Goyet J, Reding R, Sokal E, Otte J B
Service de Chirurgie Pédiatrique, Cliniques Universitaires Saint-Luc, UCL, Bruxelles, Belgique.
Chirurgie. 1997;122(2):83-7.
Encouraging results of alternative techniques used for liver transplantation in children (liver reduction) and the persistent lack of a sufficient number of cadaver donors has favored the development of living related donor liver transplantation. This program, which began after a long preparative period concerning the ethical questions involved, has included 32 children during the first 30 months. Results have been excellent. All children who underwent elective transplantations (n = 18) are still living. Among the 14 patients whose condition required hospitalization before transplantation, 86% have survived. Vascular complications and graft loss due to primary dysfunction or chronic rejection have been reduced, but 22% of the patients have biliary stenosis. In the donors, there has been no severe complication or sequelae. Use of related living donor livers has increased the number of grafts available for children on the waiting list for cadaver livers. The resulting gain in waiting time has also reduced the risk of death before transplantation. In our experience, the combination of the two transplantation programs using living donors and cadaver livers has had a positive impact on global management of children referred for liver transplantation, whatever the option chosen by the parents.
用于儿童肝移植的替代技术（肝脏缩小术）取得了令人鼓舞的成果，且尸体供体数量持续不足，这推动了亲属活体供肝肝移植的发展。该项目在经过漫长的涉及伦理问题的筹备期后启动，在最初的30个月里纳入了32名儿童。结果非常出色。所有接受择期移植的儿童（n = 18）仍存活。在14名移植前需要住院治疗的患者中，86%存活。血管并发症以及因原发性功能障碍或慢性排斥导致的移植物丢失有所减少，但22%的患者存在胆管狭窄。在供体中，未出现严重并发症或后遗症。使用亲属活体供肝增加了等待尸体肝脏移植的儿童可获得的移植物数量。等待时间的缩短也降低了移植前死亡的风险。根据我们的经验，无论父母选择哪种方案，使用活体供体和尸体肝脏的两种移植方案相结合，对接受肝移植的儿童的整体管理都产生了积极影响。
